About 30% of patients who have had my-ocardial infarction (MI) have a reoc-cluded artery within the first year of successful fibrinolysis, say researchers from the Interuniversity Cardiology Institute of the Netherlands. They found, however, that three months of heparin and coumarin therapy reduced reoc-clusion and recurrent events after successful thrombolysis by 45%.
The Antithrombotics in the Prevention of Reocclusion in Coronary Thrombolysis (APRICOT)-2 trial included 308 patients who had a patent infarct-related artery 48 hours after fibrinolysis. Patients were randomly assigned to standard hepariniza-tion therapy and continuation of aspirin alone or to three months of aspirin therapy with moderate-intensity coumarin as well as continued heparin.
At three months, only 15% of patients taking coumarin plus aspirin experienced reocclusion compared to 28% taking aspirin alone. Only 2% had a new MI, compared to 8% taking aspirin. Only 13% needed revascularization, compared with 31% receiving aspirin. The reocclusion rate for patients taking fibrin-specific lyt-ics was 17%, versus 24% for those taking non–fibrin-specific agents. Bleeding was infrequent.